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Background :Cryolipolysis has emerged as a nonsurgical fat reduction alternative to liposuction. Industry payments may impact how physician authors view medical devices in the literature. Under-reporting financial conflicts of interest has raised concerns about full transparency between industry and physicians. Objectives :We aim to determine the impact industry payments to physicians have on the cryolipolysis literature and whether there is under-reporting of financial conflicts of interest in the literature. Methods :We collated all articles that cite the pivotal trial in the Food and Drug Administration approval of a cryolipolysis device. Articles were read independently and coded as favourable or neutral. A separate researcher screened the Centers for Medicare & Medicaid Services Open Payments database for direct or in-kind payments and recorded financial conflicts of interest. Results :A total of 19 articles met the inclusion criteria. This included 37 unique authors across multiple specialties. Eighteen (95%) published articles had at least one author who received industry payment. Payments totalled $1,476,564.16. Twelve (63%) articles were positive, and 7 (37%) neutral. Of the 31 authors who received payments, 11 (35%) did not report a conflict of interest. The majority of industry payments assessed were for consulting fees, which totalled $980,334.86 (66.4%). Conclusions :We found the majority of published opinions on cryolipolysis from the United States were written by physicians who received industry payments. We also found financial conflicts of interest around cryolipolysis devices are under-reported in the literature.

Background:Breast implants were first introduced in the 1960s and have long been used for augmentation and reconstructive breast surgery. More recently, fat grafting for breast augmentation has gained popularity due to the ‘natural’ outcome and lack of implant-related complications. The aim of this study was to conduct a systematic review and meta-analysis comparing patient-related outcome measures between fat grafting and implant-based primary augmentation using the validated BREAST-Q questionnaire. Methods:A systematic review of the literature according to the PRISMA guidelines was conducted in PubMed®, Cochrane Library®, EMBASE®, MEDLINE®, and Scopus® databases. Papers were screened by two independent blinded reviewers. Quality was assessed using MINORS criteria. Results:Fourteen studies were included in the meta-analysis representing a total of 81 fat grafting augmentations and 1535 implant augmentations. The average overall patient satisfaction mean post-operative scores were 13.0 points higher in the implant group based on meta-regression (95% CI: 2.4-23.5; P= .016). There was no statistical difference in reported post-operative sexual well-being, psychosocial well-being, or physical well-being BREAST-Q scores. Conclusion:Although implant-based augmentation resulted in higher post-operative overall satisfaction scores, fat grafting remains a highly desirable alternative for augmentation in the right patient. This meta-analysis strongly highlights that careful patient selection and evaluation of patient goals must be assessed when selecting an augmentation method.

Background: Otolaryngology-Head and Neck Surgery (OHNS) electives provide medical students opportunities for knowledge acquisition, mentorship, and career exploration. Given the importance of electives on medical student education, this study examines OHNS clinical electives prior to their cancellation in 2020 due to the COVID-19 pandemic. Methods: An anonymous 29-question electronic survey was created using the program “Qualtrics.” Themes included elective structure and organization, elective clinical and non-clinical teaching, evaluation of students, and the influence of electives on the Canadian Residency Match (CaRMS). The survey was distributed through the Canadian Society of Otolaryngology e-newsletter and e-mailed to all OHNS undergraduate and postgraduate program directors across Canada. Results: Forty-two responses were received. The vast majority of respondents felt that visiting electives were important and should return post-COVID-19 (97.6%). Most said they provide more in-depth or hands-on teaching (52.4% and 59.6%, respectively). However, there was great variability in the feedback, types of teaching and curriculum provided to elective students. It was estimated that 77% of current residents at the postgraduate program that responders were affiliated with participated in an elective at their program. Conclusions: Prior to the cancellation of visiting electives in 2020 due to the COVID-19 pandemic, electives played an important role in OHNS undergraduate medical education and career planning for students wishing to pursue a career in OHNS. Electives also provide the opportunity for the evaluation of students by OHNS postgraduate programs.